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He has also received numerous awards and honors for his extensive humanitarian work and involvement with charitable organizations. He is a supporter of various veterans' organizations and founded the Lt. Dan Band (named after his character in Forrest Gump), which plays at military bases around the world.

His acting career started on stage with the Steppenwolf Theatre Company in 1983 when he directed and starred in a production of Sam Shepard's True West for which he earned a Obie Award. He would later earn four Tony Award nominations including for his performances in The Grapes of Wrath and One Flew Over the Cuckoo's Nest. He earned the Tony Award's Regional Theatre Award alongside the Steppenwolf Theatre Company.

He first starred in the film adaptation of John Steinbeck's classic novel Of Mice and Men which he also directed and produced. Sinise played George Milton alongside John Malkovich who played Lennie.

One of his most well-known roles is as Lieutenant Dan Taylor in Forrest Gump (1994) for which he was nominated for the Academy Award for Best Supporting Actor. He also appeared in other feature films including Ron Howard's Apollo 13 (1995), Ransom (1996), Frank Darabont's The Green Mile (1999) and Impostor (2002).

His television performances include Harry S. Truman in Truman  (1995), for which he won a Golden Globe, and the title role in the television film George Wallace, for which he received a Primetime Emmy Award.

He had a leading role as Detective Mac Taylor in the CBS drama series CSI: NY (2004–13). From 2016 to 2017, he starred as Special Agent Jack Garrett in Criminal Minds: Beyond Borders. In 2017, he had a role on the Netflix series 13 Reasons Why.

He has also been a narrator on multiple docuseries and documentaries.